High prevalences of vitamin B 12 and folic acid deficiency in elderly subjects in Israel Elizabeth Figlin, 1 Angela Chetrit, 2 Avner Shahar, 3 Ofer Shpilberg, 4 Ariella Zivelin, 1 Nurit Rosenberg, 1 Frida Brok-Simoni, 1 Nathan Gadoth, 5 Ben-Ami Sela 6 and Uri Seligsohn 1 1 Department of Hematology, Institute of Thrombosis and Hemostasis, 2 Gertner Institute for Epidemiology and Health Research Policy, Chaim Sheba Medical Centre, Tel-Hashomer and Sackler Faculty of Medicine, Tel Aviv University, 3 Harzfeld Geriatric Hospital, Gedera, 4 Department of Hematology, Soroka Medical Centre and Ben Gurion University, Beer Sheva, 5 Department of Neurology, Meir General Hospital, Sapir Medical Centre, Kfar Saba, and 6 Institute of Chemical Pathology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel Received 1 July 2003; accepted for publication 13 August 2003 Summary. The prevalences of vitamin B 12 and folic acid deficiency in the general Israeli population of elders has not been assessed. We measured plasma cobalamin and folic acid concentrations in 418 subjects from four institutions for the aged, 749 subjects attending 19 geriatric day centres and 104 healthy controls. Methylmalonic acid (MMA) and/ or homocysteine concentrations were determined in sub- jects who had a cobalamin concentration <221 pmol/l or folic acid concentration <11 nmol/l respectively. The pre- valences of vitamin B 12 deficiency (cobalamin <147 pmol/l and MMA ‡0Æ24 lmol/l), and folic acid deficiency (folic acid <11 nmol/l and homocysteine of >15 lmol/l) in subjects from day centres were 12Æ6% and 16Æ4% respectively, and in subjects from institutions 1Æ2% and 2Æ2% respectively (P <0Æ001). Multiple logistic regression analysis indicated that the relative risk of living at home versus institutions for the aged was highly significant, with odds ratios (OR) of 6Æ8 [95% confidence interval (CI) 2Æ6–18Æ0] for vitamin B 12 deficiency and 6Æ6 (95% CI 2Æ9–13Æ1) for folic acid defici- ency. Analysis of data for day centre patients showed that folic acid deficiency was a significant risk factor of vitamin B 12 deficiency (adjusted OR 3Æ68, 95% CI 2Æ27–5Æ98), and vitamin B 12 deficiency was a significant risk of folic acid deficiency (adjusted OR 3Æ69, 95% CI 2Æ27–6.01). These data suggest that malnutrition is a major cause of the highly prevalent deficiencies of vitamin B 12 and/or folic acid in elderly Israeli subjects dwelling at home. Keywords: vitamin B 12 deficiency, folic acid deficiency, methylmalonic acid, homocysteine, cobalamin deficiency. Early studies showed that the prevalence of subnormal concentrations of vitamin B 12 in elderly persons ranged from 3Æ0–40Æ5%, depending on the diagnostic criteria used (Baik & Russell, 1999). More recent studies, based on finding increased concentrations of methylmalonic acid (MMA) and homocysteine, apart from decreased cobalamin concentrations, indicated that vitamin B 12 deficiency affected 12–15% of subjects aged 60 years or older (Pennypacker et al, 1992; Lindenbaum et al, 1994; Carmel et al, 1999; Rajan et al, 2002). Interestingly, a significantly higher prevalence of the deficiency was observed in whites compared with African-Americans and Asians (Carmel et al, 1999). The cause for the deterioration of the vitamin B 12 status in most affected elderly subjects has not been established, but its impact on neuropsychiatric morbidity, even when unaccompanied by signs of megaloblastic anemia, can be substantial (Lindenbaum et al, 1988). The prevalence of folic acid deficiency in the elderly has varied substantially in different study groups, with frequen- cies of 0–19% being reported (Joosten et al, 1993; Lind- enbaum et al, 1994; Van Asselt et al, 1998; Carmel et al, 1999). In a recent study, we observed a relatively high prevalence of both folic acid and cobalamin deficiency in 640 elderly patients admitted to a geriatric hospital in Israel (Shahar et al, 2001). Folic acid concentrations of <13Æ6 nmol/l were found in 27Æ3% of the patients, and cobalamin concentrations of <110 pmol/l were observed in 15% of the patients. The aims of the current study were to prospectively determine whether the prevalences of cobalamin and folic acid deficiency states are also high in community-dwelling Correspondence: Uri Seligsohn, Institute of Thrombosis and Hemostasis, Chaim Sheba Medical Centre, Tel-Hashomer 52621, Israel. E-mail: seligson@sheba.health.gov.il British Journal of Haematology, 2003, 123, 696–701 696 Ó 2003 Blackwell Publishing Ltd